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Recognising Kawasaki disease in UK primary care: a descriptive study using the Clinical Practice Research Datalink
Abigail Moore1, Anthony Harnden1, Richard Mayon-White1
1Department of Primary Health Care Sciences, University of Oxford, Oxford.
Insights
Early diagnosis of Kawasaki disease (KD) is challenging due to non-specific symptoms in primary care. Most children develop recognizable KD symptoms only upon hospital admission, highlighting the need for increased physician awareness.
Area of Science:
- Pediatric infectious diseases
- Diagnostic challenges in primary care
- Rare childhood illnesses
Background:
- Kawasaki disease (KD) is a rare pediatric illness with non-specific initial symptoms, posing diagnostic difficulties.
- The early clinical presentation of KD in UK primary care settings has not been well-documented.
Purpose of the Study:
- To characterize the initial primary care presentation of children who were eventually diagnosed with Kawasaki disease in the UK.
Main Methods:
- Utilized the Clinical Practice Research Datalink to identify potential KD cases.
- Confirmed diagnoses using Hospital Episode Statistics, hospital admissions, and outpatient attendance data.
- Sent questionnaires and requested medical records from General Practitioners (GPs) for 104 confirmed KD cases (2007-2011).
Main Results:
- Most children presented with few classic KD features; fever or rash were most common when only one feature was present.
- By hospital admission, a more recognizable syndrome with three or more KD features was typically observed.
- GPs rarely included KD in their differential diagnoses, though some noted unusual illness patterns.
Conclusions:
- Early diagnosis of KD is difficult due to non-specific primary care presentations.
- GPs should practice diligent safety netting and consider KD in children with fever and rash.
- Improved awareness of KD's varied presentation in primary care is needed.
Background:
Kawasaki disease is a rare childhood illness that can present non-specifically, making it a diagnostic challenge. The clinical presentation of Kawasaki disease has not been previously described in primary care.
Aim:
To describe how children with an eventual diagnosis of Kawasaki disease initially present to primary care in the UK.
Design And Setting:
The Clinical Practice Research Datalink was used to find cases coded as Kawasaki disease. Hospital Episode Statistics, hospital admissions, and hospital outpatient attendances were used to identify the children with a convincing diagnosis of Kawasaki disease.
Method:
Questionnaires and a request for copies of relevant hospital summaries, discharge letters, and reports were sent to GPs of the 104 children with a diagnosis of Kawasaki disease between 2007 and 2011.
Results:
Most children presented with few clinical features typical of Kawasaki disease. Of those with just one feature, a fever or a polymorphous rash were the most common. By the time that most children were admitted to hospital they had a more recognisable syndrome, with three or more clinical features diagnostic of Kawasaki disease. Most GPs did not consider Kawasaki disease among their differential diagnoses, but some GPs did suspect that the child's illness was unusual.
Conclusion:
The study highlighted the difficulty of early diagnosis, with most children having a non-specific presentation to primary care. GPs are encouraged to implement good safety netting, and to keep Kawasaki disease in mind when children present with fever and rashes.
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